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Home My WebLink About20256-z · o~ No. ~ TOWN O~ $OU~OL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NE 20256 Z Permission is hereby granted to: ~/ .~~~,~..., .......... .~... ...... ~. ......... ~...~ .................... -- ~ ...... 7' ..... ~. ~,~/,;~,.,~ ..... .~:~/~...? ........... ~ ~.,~ .......... ../.~,Z..~./. ........ /.-./... z~. ~..~ .~..o...~..~./...e.. ~...a ..~..z ...~.. .................. at premises located at .....~.?~....~..~...~~,~X~...~. ................................................................. cou,~ Tox Mop No. 7000 Sect,on ..... Z~ ........... mock ....~. ............ Lot No .......... ~ ......... pursuant to application dated ...~'../.~7. ...................................... , 19..~./..., and Building Inspector. approved by the \ Rev. 6/30/80 -;--'. ,iY ~ [ '-~ ~ FORM NO. 1 / ; TOWN OF SOUTHOLD · BUILDING DEPARTMENT " TOWN HALL I SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ^pprov d .... 19..:PermitNo. * q. D,sapproveda/c t., / / '7',k~'/' -,; ........ (Building Inspector) APPLICAT!ON FO,~. BU!LDP',JG PERM .T BOARD OF HEALTtl ......... 3 SETS OF PLA~$ .......... SURVEY ................... CIIECK CALL ................... HAIL TO: INSTRUCTIONS ~a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;eB of plans, accurate plot plan to scale. Fee according to schedule. j~b. Plot plan showing location o£ lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- zation. c. The work covered by this applica{ion may not be c~mmenced before issuance of Building Permit· d. Upon approval o£ this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ihal! be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ~hail have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the 3uildi~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable laws~ Ordinances or ilegulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. l'l~e app, licant agrees to comply with all applicable laws, ordinances b~rflding co"d~ ~g code,~and regulations, and to ~dmit author/zed inspectors on premises and in building for necessaj3/~i~~ 't/'£.]/~__L~.~--~/)+ ~"'~[ ;~, ~r~name, if a corporation)~ -- '~i'g~lat ure~o f a~ ............................... (Mai~ ig address of applicant) State whether applicant ~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner ofpremises..{4J....~.~/).0~..~...,T,· p~ .J.~-...'.~..~./q.~£/ ~ ~.~,2'~0 * . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate 'officer) Builder's License No... ~dJ~ ........ Piton bet's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Locationoflandonwhichproposedworkyvillli~done..}.~.~.~-..¥~..~??ff.~ _~?A ...... ............... er Street Hamlet Co,,n' a. MapNo. lOOOSec,ion .... .9..g'.. ........ Block .... ........... Lo, / Subdivision ................ (~am~) ................ Filed Map No ............... Lot ............... State existing use and occupancy of premises and intended use and~occupancy of proposed construction: a. Existing use and occupancy.. ~/.a .~ ~.~..~..D;~, <,~,. ~.~t ~'~'~ C~ b In, ndduse d 's~'gt~T~AE ' · e e an occupancy ................. .---.....~. ' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work...,~.~..,~..C'.O..~-1.. 4. Estimated Cost ...... ~ ....................... (to be paid on filing this application) 5. If dwelling, number of dwelling uJnits ..... ! ......... Number of dwelling units on each floor ................ · If garage, number of cars ..... i, .................................................................. 6. If business, commercial or mixedloccupaney, specify nature and extent of each type of use 7~ Dimensions f ........................ o existing structuresI if any Front ......... Rear .............. Depth ............... Height ............... NumOer of Stories .......................... Dimensions of same structure with alterations or additions: Front .......... .... ' i i ' ' ' i 'Rear .................. ............ ~ ...... Depth ..................... I · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ........... ; · ·. Rear ............... Depth ............... ~ Height Number of Stones 9. Size of lot' Front I . . Rear I I. Lone or use district in which prer~ises are situated ...................... ~ ............................. 12. Does proposed construction violate any zonin,,/aw ordinance ,,--~o,l.~t~,~,,. ~ I3. Will lot be regraded ....... _P~..,~l. .... Will excess fill be removed from premises~ 'es Name of Contractor ./L/.~ . ,.t.L~ ~.-.--. 15. Is thio property within 300 feet of a tidal wetland? *Yes..'.~..'.. · If yes, SouthdZd Tpwn Trustees Permit may be required. Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block nCmber or descriptio~ according to deed, and show street names and indicate whether interior or comer lot. _._ ~S~ NO~IOO~,/SNO3 / ~ ~ 'A ~:~.~ :ou v oF ........ s. ..: ................ ......... .... ,...h.J... being duly sworn, deposes ~d says that he is the applicant (Name of individual signin :contract) bore named. , said owner or owners, ~d is duly ~uthorized to perform or have perfo~ed the said work and to m~e ~d file this pplication; that ail statements contained ~ this application are true to the best of his knowledge and belief; and that the ,'ork will be perfomed in the m~ner s~t forth in the application filed therewith, worn to before me this ........... ~ .~ ........ ~ ...... Co~.t. BAR~/',~ ,A EASA e' ~" ", of Now York NOTAR